PROJECT SUMMARY Surgery remains a high-risk endeavor, with upwards of 4000 ?never? events per year, and multiple additional opportunities for accidental injuries. Though new surgical technologies are intended to benefit patients, they can introduce unexpected new complexities and error modes for which operating room (OR) teams and host organizations may be unprepared. One of the most ubiquitous exemplars of high-technology surgery is robotic assisted surgery (RAS), which has demonstrated benefit, but also introduces a range of new challenges that place additional stresses on communication, technical and procedural knowledge within the team, and the available space in the operating room. We will evaluate multiple interventions to address these specific challenges, testing new approaches to teamwork training, task design, and workspace management both individually and in combination, at 4 different hospital sites. The effects will be evaluated at individual (use of intervention; workload), process (surgical durations and disruptions) and systems (complications and safety culture) levels. Qualitative interviews and observations will be used to understand the implementation and spread of the interventions. Finally, data from the 680 planned surgical observations ? the largest direct observation study ever conducted ? will be used to model accident causation by exploring the mechanism by which small innocuous process problems concatenate into more serious risks and eventual injuries. This will fundamentally improve our understanding of how innovative surgical technologies can be safely deployed and integrated within complex clinical work systems.